July Journal Round-Up – Head & Neck

Phil Touska is the new trainee representative for the British Society of Head and Neck Imaging (BSHNI), and here’s his thoughts on the most recent and relevant publications in head and neck radiology:

Head & Neck Cancer

AJCC 8 is on its way and promises to improve the accuracy of staging and correlation with survival and reflects more recent data. The main changes include separate staging for HPV related and non-HPV related SCC, reflecting the more favourable prognosis of HPV related disease. In addition, depth of invasion is now included in the staging of oral cancer (small, but deeply invasive lesions carry a worse prognosis) and there is a new N3b stage for non-HPV related SCC, reflecting extranodal spread (Lydiatt et al. Jan 2017).

Otology

Whilst the ‘third eye’ might provide insight, the ‘third window’ is associated with a diminution of the senses, hearing loss in particular. Although many of us may have come across semicircuar canal dehiscence, the aetiology of the associated hearing loss and the spectrum of similar conditions may be less familiar. Ho et al. provide an excellent insight into the various different abnormalities that may cause ‘third window’ defects (Ho et al.  2017).

Rhinology

A group of rhinologists have recently convened to discuss the scintillating topic of the frontal sinus and its drainage pathway. This resource is helpful if you are communicating with surgeons carrying out endoscopic procedures in this region, alerting them to supra-agger or supra bulla cells (Wormald et al. 2016). A further helpful resource on frontal sinus drainage pathway anatomy can be found in the AJNR (Daniels et al. 2003).

Trauma

Reviewing soft tissue radiographs of the neck for foreign bodies can occasionally result in confusion and pitfalls abound. If you have ever wondered about the location of the triticeous cartilage or wanted to know the ossification patterns of the cricoid and aretyoid cartilages, look no further than Radiographics (Castan Senar et al. 2017), free for RSNA members.

Techniques

There is increasing interest in the use of dual energy CT in the head and neck. It works on the principle of imaging at two tube voltages, the photoelectric effect predominating at the lower voltage; hence, enhancing lesions will attenuate more, increasing conspicuity. The technique can also be used to isolate iodine creating ‘iodine maps’ to delineate lesions, create virtual non-contrast studies and reduce deleterious metal artefact Roele et al. 2017 and Vogl et al. 2012.

Phil can be contacted on bshnitrainees@gmail.com. Look out for his summary of the 2017 British Society for Head and Neck Imaging Annual Meeting coming later this week!

 

  • Lydiatt WM, Patel SG, O’Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, Loomis AM, Shah JP. Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017 Mar;67(2):122-137.
  • Ho ML, Moonis G, Halpin CF, Curtin HD. Spectrum of Third Window Abnormalities: Semicircular Canal Dehiscence and Beyond. AJNR Am J Neuroradiol. 2017 Jan;38(1):2-9.
  • Castán Senar A, Dinu LE, Artigas JM, Larrosa R, Navarro Y, Angulo E. Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common Pitfalls. Radiographics. 2017 Jan-Feb;37(1):323-345.
  • Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ, Senior BA, Smith TL, Hwang PH, Orlandi RR, Kaschke O, Siow JK, Szczygielski K, Goessler U, Khan M, Bernal-Sprekelsen M, Kuehnel T, Psaltis A. The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS). Int Forum Allergy Rhinol. 2016 Jul;6(7):677-96.
  • Daniels DL, Mafee MF, Smith MM, Smith TL, Naidich TP, Brown WD, Bolger WE, Mark LP, Ulmer JL, Hacein-Bey L, Strottmann JM. The frontal sinus drainage pathway and related structures. AJNR Am J Neuroradiol. 2003 Sep;24(8):1618-27.
  • Roele ED, Timmer VCML, Vaassen LAA, van Kroonenburgh AMJL, Postma AA. Dual-Energy CT in Head and Neck Imaging. Curr Radiol Rep. 2017;5(5):19.
  • Vogl TJ, Schulz B, Bauer RW, Stöver T, Sader R, Tawfik AM. Dual-energy CT applications in head and neck imaging. AJR Am J Roentgenol. 2012 Nov;199(5 Suppl):S34-9.

July Journal Round-Up

Welcome to the July journal round-up! This month we are privileged to welcome the British Society of Head and Neck Imaging’s trainee representative, Phil Touska, who has kindly written a companion round-up for head and neck radiology. Also look out for his summary of the recent BSHNI Annual Meeting on this blog next week. But to start with, this month’s neuro…

Emergency – Two review articles published this month on very different topics both illustrate the vital importance of understanding the clinical context when interpreting imaging. Siddiqui et al. in Emergency Radiology tackle the tricky area of the craniocervical junction and associated traumatic injuries, with reference to appropriate neurosurgical management. Similarly, in AJR Reiter et al. cover normal postoperative appearances following traumatic midface fractures and associated complications, focusing on understanding the operative techniques used to maximize utility to the maxillofacial surgeons.

Vascular/Intervention Caldwell et al. in Practical Neurology have written a concise and practical summary of acute stroke imaging covering important pitfalls in interpretation and appropriate imaging pathways. Within the setting of stroke, a number of articles this month focus on areas requiring further research following the major mechanical thrombectomy trials – for example, Satti et al. performed a retrospective review of mechanical thrombectomy in a paediatric population; although good recanalization rates and clinical outcomes were demonstrated, only 29 patients were included so further work is required. Hoving et al. looked at intracranial occlusions secondary to internal carotid artery dissections, and a systematic review also demonstrated largely favourable outcomes from endovascular treatment, but noted that the studies included were mainly case reports/series so again only limited conclusions could be drawn.

Away from vascular intervention, the trials and tribulations of image-guided lumbar puncture have been on the agenda, with a pragmatic problem-solving approach in AJNR to difficult adult LPs and a guide to ultrasound-guided paediatric LPs in Pediatric Radiology.

Tumour – In JNNP this month, Voets et al. review the white matter tracts pertinent to neuro-oncology treatment, covering functional and anatomical aspects and providing a thorough overview of the relevant tracts which will act as a useful reference guide. Another area of increasing importance in neuro-oncology is radiogenomics and the molecular-radiologic correlations following the updated WHO classification, and Smits and van den Bent have provided a detailed analysis of the known imaging features of glioma subtypes in Radiology – this will become increasingly important in neuro-oncology MDTs.

Inflammatory – With the uncertainty about gadolinium deposition continuing to feature heavily in the literature, Gupta et al. have looked into other ways of imaging disease activity in multiple sclerosis without the use of contrast, performing a meta-analysis and demonstrating some promise for DTI (fractional anisotropy).

Degenerative – A large scale study from Iceland published in JAMA Neurology examined the relevance of large perivascular spaces, and found that they are associated with a significantly increased risk of vascular dementia and are a marker for small vessel disease – and thus should be reported in cognitive impairment studies in the older population. In JNNP, Gellersen et al. examined cerebellar atrophy and found in a systematic review that patterns of atrophy were useful in discriminating neurodegenerative diseases. It is also a helpful reminder of the functional anatomy and connectivity of the cerebellum.

Paediatric – Hypoxic ischaemic encephalopathy in neonates can be difficult to diagnose and prognosticate from on MRI. A study by Trivedi et al. in Pediatric Radiology validates an MRI scoring system that can be used clinically, and was shown to predict neurodevelopmental outcomes at 18-24 months. Although multiple scoring systems exist, the authors contend that this is the first to incorporate DWI and this provides at the very least a practical checklist for abnormalities to assess for in the setting of HIE.

Hacohen et al. have developed a diagnostic algorithm for CNS demyelination in children, summarising discriminating radiological and laboratory test features between different demyelinating diseases, and highlighting imaging features of MOG-related disease.

Spine – In AJR, Anderson et al. have reviewed the imaging findings in chronic adhesive arachnoiditis, providing a helpful guide to this heterogeneous but debilitating disorder.

Particularly important for centres that perform aortic intervention, Gialdini et al. have investigated the occurrence of spinal cord infarction following aortic dissection and aneurysm repair. They found an incidence of 1/130 in dissection or ruptured aneurysm repair and 1/600 in unruptured aortic repair, which is important both for the vigilance of the neuroradiologist in this setting and communication of risk by the interventionalist.

Other – Contrast agents remain hot topics and whilst we worry about gadolinium deposition, there is good news from the CT side with a systematic review and meta-analysis by Brinjikji et al. which provides nonrandomized evidence that contrast given in the setting of acute stroke (CTA/CT perfusion) is not associated with acute kidney injury even in patients with chronic kidney disease.

And finally, for all those exhausted by multiple pineal cyst referrals to MDTs, you may wish to distribute Ramji et al.’s valuable pictorial review on normal neuroanatomical variants that can be misinterpreted to your referrers (after a careful peruse yourself!).

That’s all for neuro this month, but please click here to go on to Phil’s excellent roundup for head and neck imaging…

 

  1. Siddiqui J, Grover PJ, Makalanda HL, Campion T, Bull J, Adams A. The spectrum of traumatic injuries at the craniocervical junction: a review of imaging findings and management. Emerg Radiol. 2017 Aug 1;24(4):377–85.
  2. Reiter MJ, Schwope RB, Theler JM. Postoperative CT of the Midfacial Skeleton After Trauma: Review of Normal Appearances and Common Complications. American Journal of Roentgenology. 2017 Jul 13;W1–11.
  3. Caldwell J, Heran MKS, McGuinness B, Barber PA. Imaging in acute ischaemic stroke: pearls and pitfalls. Practical Neurology. 2017 Jul 25;practneurol-2016-001569.
  4. Satti S, Chen J, Sivapatham T, Jayaraman M, Orbach D. Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature. Journal of NeuroInterventional Surgery. 2017 Aug 1;9(8):732–7.
  5. Hoving JW, Marquering HA, Majoie CBLM. Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review. Neuroradiology. 2017 Jul 1;59(7):641–7.
  6. Hudgins PA, Fountain AJ, Chapman PR, Shah LM. Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches. American Journal of Neuroradiology. 2017 Jul 1;38(7):1276–83.
  7. Muthusami P, Robinson AJ, Shroff MM. Ultrasound guidance for difficult lumbar puncture in children: pearls and pitfalls. Pediatr Radiol. 2017 Jun 1;47(7):822–30.
  8. Voets NL, Bartsch A, Plaha P. Brain white matter fibre tracts: a review of functional neuro-oncological relevance. J Neurol Neurosurg Psychiatry. 2017 Jul 14;jnnp-2017-316170.
  9. Smits M, van den Bent MJ. Imaging Correlates of Adult Glioma Genotypes. Radiology. 2017 Jul 19;284(2):316–31.
  10. Gupta A, Al-Dasuqi K, Xia F, Askin G, Zhao Y, Delgado D, et al. The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis. American Journal of Neuroradiology. 2017 Jul 1;38(7):1317–22.
  11. Ding J, Sigurðsson S, Jónsson PV, Eiriksdottir G, Charidimou A, Lopez OL, et al. Large Perivascular Spaces Visible on Magnetic Resonance Imaging, Cerebral Small Vessel Disease Progression, and Risk of Dementia: The Age, Gene/Environment Susceptibility–Reykjavik Study. JAMA Neurol [Internet]. 2017 Jul 17 [cited 2017 Jul 27]; Available from: http://jamanetwork.com/journals/jamaneurology/fullarticle/2643984
  12. Gellersen HM, Guo CC, O’Callaghan C, Tan RH, Sami S, Hornberger M. Cerebellar atrophy in neurodegeneration—a meta-analysis. J Neurol Neurosurg Psychiatry. 2017 May 27;jnnp-2017-315607.
  13. Trivedi SB, Vesoulis ZA, Rao R, Liao SM, Shimony JS, McKinstry RC, et al. A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol. 2017 Jun 16;1–9.
  14. Hacohen Y, Mankad K, Chong WK, Barkhof F, Vincent A, Lim M, et al. Diagnostic algorithm for relapsing acquired demyelinating syndromes in children. Neurology. 2017 Jul 18;89(3):269–78.
  15. Anderson TL, Morris JM, Wald JT, Kotsenas AL. Imaging Appearance of Advanced Chronic Adhesive Arachnoiditis: A Retrospective Review. American Journal of Roentgenology. 2017 Jun 22;1–8.
  16. Gialdini G, Parikh NS, Chatterjee A, Lerario MP, Kamel H, Schneider DB, et al. Rates of Spinal Cord Infarction After Repair of Aortic Aneurysm or Dissection. Stroke. 2017 Jan 1;STROKEAHA.117.017071.
  17. Brinjikji W, Demchuk AM, Murad MH, Rabinstein AA, McDonald RJ, McDonald JS, et al. Neurons Over Nephrons. Stroke. 2017 Jul 1;48(7):1862–8.
  18. Ramji S, Touska P, Rich P, MacKinnon AD. Normal neuroanatomical variants that may be misinterpreted as disease entities. Clinical Radiology [Internet]. 2017 Jul 23 [cited 2017 Jul 27];0(0). Available from: http://www.clinicalradiologyonline.net/article/S0009-9260(17)30348-3/fulltext

 

June Journal Round-Up

Welcome to the June neuroradiology journal round-up! Below are some of the most useful articles (in my humble opinion) for neuroradiology trainees from this month, separated into categories – do let me know of any you think should be on here!

Emergency – When it comes to emergency neuroimaging this month, the eyes have it; both Emergency Radiology and Radiographics have articles focusing on this potential ‘blind spot’ for radiologists. Thelen et al. present a concise pictorial review of post-traumatic injuries, while Nguyen et al. cover a more all-encompassing range of orbital pathologies including infection, trauma, vascular disease and inflammation. Taken together, they are a useful reminder and reference for an important review area on the emergency CT head.

Also in Emergency Radiology, a sadly ever more relevant overview of penetrating brain trauma by Vakil and Singh focuses on bullet injuries. A particularly interesting section focuses on the wound types caused by different motion of the bullet at time of impact, with implications for ongoing management and prognosis, and there is an equally important discussion of complications following these injuries.

Vascular – Intracranial vascular malformations have been a hot topic this month, with an overview of cerebral arteriovenous malformation imaging in AJR timed perfectly to coincide with a consensus statement on their management in Stroke, which provides important clinical context for neuroradiologists as well as more direct management guidance for interventionalists.

Also in Stroke, there is a comprehensive topical review of dural arteriovenous malformations by Reynolds et al., and the supplemental material contains detailed information on treatment options and outcomes.

Away from vascular malformations, an editorial in Neurology by Carrera and Wintermark examines the issue of imaging-based selection for acute stroke treatment, and essentially the utility of perfusion CT in this context, which will presumably become more and more relevant in the era of mechanical thrombectomy.

Intervention – Interventionalists will be interested to read the concise multi-organisation working group consensus guidelines for ‘Standards of Practice in Interventional Neuroradiology’ published in Neuroradiology this month. Perhaps with some relevance to these standards, in JNNP early results from a trial of clipping versus coiling of unruptured aneurysms demonstrated no difference in morbidity at one year, but an increase in neurological deficits and hospitalisation of over five days in the clipping group.

Inflammatory/Infection – The gamut of imaging findings in viral infections of the CNS can be bewildering, and a virus-by-virus breakdown in Emergency Radiology serves as a handy reference guide. Similarly, there is an expanding subset of autoimmune encephalitides, and an open access AJNR review by Kelley et al. dives into the distinguishing features and clinical importance of the different subtypes – particularly striking is the apparent prevalence of NMDA receptor encephalitis in young patients with limbic encephalitis (apparently more than any single viral aetiology in young patients, according to the California Encephalitis Project). Elsewhere, a pragmatic and worthwhile update on multiple sclerosis imaging in the BJR by Igra et al. focuses on diagnostic criteria and treatment related complications.

Degenerative – As the article by Harper et al. in JNNP points out, imaging studies in dementia rarely have pathological confirmation of dementia type, so this study of 215 pathologically confirmed people with dementia is a very valuable resource for delineating patterns of atrophy and will hopefully have practical clinical applications.

PaediatricHaverkamp et al. provide an overview and pictorial essay of paediatric spinal neoplasms in this month’s Neurographics, with useful summary differential diagnosis tables for lesions in each spinal compartment, and there is a focus on surrounding further investigations and management for each pathology.

Spine – In JNS Spine this month, Schultz et al. offer some tips for the clinicoradiological conundrum of differentiating dorsal arachnoid webs from anterior spinal cord herniation, performing a cohort study of a small number of patients with each. The most useful signs to differentiate the two were the shape of the dorsal indentation (‘scalpel-shaped’ in DAW, ‘C-shaped’ in SCH) and the presence of a preserved ventral CSF plane in DAW.

Other – Synthetic MRI is an exciting prospect, potentially allowing multiple sequences to be reconstructed from a single scan and thereby significantly reducing scan times, but its potential has not yet been fully assessed. The MAGiC prospective trial, published in AJNR, takes a significant leap in that direction, demonstrating noninferiority of multiple sequences, although currently with increased artefacts affecting T2 FLAIR. Watch this K-space!

With growing interest in the long-term effects of repeated Gadolinium agent administration, ISMRM has published a summary of the evidence along with their recommendations for clinical and research use in the Lancet Neurology – the driving point of which is that we know that gadolinium is deposited, but we do not know what the biological significance of this is as yet and further research is required.

Finally, a great excuse for medical students at the back of lecture halls everywhere – students who spent longer playing on a smartphone game performed better on a simulated interventional radiology task (renal artery cannulation) in an article in Clinical Radiology, and only in those who played for more than 5 hours a week. So that’s what all those interventionalists sitting in meetings are doing…

That’s all for now. Let me know if you find these articles helpful, and about anything else you’ve been reading this month!

 

References

1. Thelen J, Bhatt AA, Bhatt AA. Emergency orbital pathology: what the radiologist should know. Emerg Radiol. 2017 Jun 17;1–8.
2. Nguyen VD, Singh AK, Altmeyer WB, Tantiwongkosi B. Demystifying Orbital Emergencies: A Pictorial Review. RadioGraphics. 2017 Apr 21;37(3):947–62.
3. Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol. 2017 Jun 1;24(3):301–9.
4. Tranvinh E, Heit JJ, Hacein-Bey L, Provenzale J, Wintermark M. Contemporary Imaging of Cerebral Arteriovenous Malformations. American Journal of Roentgenology. 2017 Mar 7;208(6):1320–30.
5. Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, et al. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017 Jan 1;STR.0000000000000134.
6. Reynolds MR, Lanzino G, Zipfel GJ. Intracranial Dural Arteriovenous Fistulae. Stroke. 2017 May 1;48(5):1424–31.
7. Carrera E, Wintermark M. Imaging-based selection of patients for acute stroke treatment Is it ready for prime time? Neurology. 2017 Jun 13;88(24):2242–3.
8. Jansen O, Szikora I, Causin F, Brückmann H, Lobotesis K. Standards of practice in interventional neuroradiology. Neuroradiology. 2017 Jun 1;59(6):541–4.
9. Darsaut TE, Findlay JM, Magro E, Kotowski M, Roy D, Weill A, et al. Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomised trial. J Neurol Neurosurg Psychiatry. 2017 Jun 20;jnnp-2016-315433.
10. Maller VV, Bathla G, Moritani T, Helton KJ. Imaging in viral infections of the central nervous system: can images speak for an acutely ill brain? Emerg Radiol. 2017 Jun 1;24(3):287–300.
11. Kelley BP, Patel SC, Marin HL, Corrigan JJ, Mitsias PD, Griffith B. Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis. American Journal of Neuroradiology. 2017 Jun 1;38(6):1070–8.
12. Igra MS, Paling D, Wattjes MP, Connolly DJA, Hoggard N. Multiple sclerosis update: use of MRI for early diagnosis, disease monitoring and assessment of treatment related complications. BJR. 2017 Apr 26;90(1074):20160721.
13. Harper L, Bouwman F, Burton EJ, Barkhof F, Scheltens P, O’Brien JT, et al. Patterns of atrophy in pathologically confirmed dementias: a voxelwise analysis. J Neurol Neurosurg Psychiatry. 2017 May 4;jnnp-2016-314978.
14. Haverkamp BT, Nizamuddin RA, Loskutov A, Lowe LH, Adler KE. Imaging Spectrum of Pediatric Spinal Neoplasms [Internet]. 2017 [cited 2017 Jun 25]. Available from: http://asnr.publisher.ingentaconnect.com/content/asnr/ng/2017/00000007/00000003/art00001
15. Schultz R, Steven A, Wessell A, Fischbein N, Sansur CA, Gandhi D, et al. Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography. Journal of Neurosurgery: Spine. 2017 Mar 24;26(6):754–9.
16. Tanenbaum LN, Tsiouris AJ, Johnson AN, Naidich TP, DeLano MC, Melhem ER, et al. Synthetic MRI for Clinical Neuroimaging: Results of the Magnetic Resonance Image Compilation (MAGiC) Prospective, Multicenter, Multireader Trial. American Journal of Neuroradiology. 2017 Jun 1;38(6):1103–10.
17. Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. The Lancet Neurology. 2017 Jul 1;16(7):564–70.
18. Alsafi Z, Hameed Y, Amin P, Shamsad S, Raja U, Alsafi A, et al. Assessing the effects of manual dexterity and playing computer games on catheter–wire manipulation for inexperienced operators. Clinical Radiology [Internet]. 2017 May 15 [cited 2017 Jun 25];0(0). Available from: http://www.clinicalradiologyonline.net/article/S0009-9260(17)30128-9/fulltext

Welcome

The aim of this blog is to provide a resource for neuroradiology trainees (and any other interested readers), and collect useful information from other sources in one helpful package. To this end, I will post a monthly round-up of articles which I think are of interest to neuroradiology trainees, and hopefully in future expand to cover other useful resources, potentially including (but not restricted to!):

  • Course and conference reviews/updates
  • Blogs on research/publications undertaken by neuroradiology trainees by the researchers themselves
  • Advice on fellowship/consultant posts and applications

This will only be useful with your collaboration, so please do get in touch if you would like to contribute any of the above, or have any other ideas you would like to explore. I would also be interested to know which articles/resources you find useful in training, particularly any I miss in the monthly round-up, as I would like to build up a repository of useful articles to eventually complement the new curriculum.

Do get in touch via the comments below or on bsnrtrainee@gmail.com.

Tom (BSNR Trainee Rep)